169 THE RELATIONSHIPS BETWEEN SYMPTOMS, REFLUX PH VALUES, AND EXTENT OF REFLUX IN PATIENTS WITH P-CAB-RESISTANT NERD

In patients with proton pump inhibitor-resistant non erosive reflux disease (NERD) having symptoms associated with liquid reflux, there are reports that reflux symptoms are more likely to be caused by the proximal extent of the reflux and reflux where pH <5. The objective of this study was to investigate the relationships between symptoms, reflux pH values, and the extent of reflux in patients with potassium-competitive acid blocker (P-CAB)-resistant NERD. Methods The subjects were 20 patients with P-CAB-resistant NERD whose symptoms did not improve even after administration of P-CAB (vonoprazan 20 mg/day) for 2–4 weeks. Their symptom index was positive for liquid reflux in impedance–pH monitoring. We investigated reflux pH values in symptomatic and asymptomatic reflux events, proportion of symptomatic reflux events according to the reflux pH value (pH <5 or ≥ 5), proportion of symptomatic reflux events at each impedance site, and proportion of symptomatic reflux events at each impedance site according to the reflux pH value (pH <5 or ≥ 5). Results About 60% of the symptomatic reflux events were caused by reflux with pH ≥5 in patients with P-CAB-resistant NERD. The median reflux pH value for total reflux events was 5.3 and that for symptomatic reflux events was 5.2. The proportion of symptomatic reflux events caused by reflux with pH <5 was significantly higher than that caused by reflux with pH ≥5. Symptomatic reflux events for reflux with pH <5 are more likely to be caused by proximal extent. There was no difference in the proportion of symptomatic reflux events for reflux with pH ≥5 at each reflux extent site. Conclusion In patients with P-CAB-resistant NERD, their symptoms were often caused by reflux with pH ≥5. A difference in the relationship between the reflux extent site and appearance of symptoms was observed according to the reflux pH value.

Diagnostic Criteria for Gastro-esophageal Reflux Following Sleeve Gastrectomy

Background Gastro-esophageal reflux disease (GERD) post-sleeve gastrectomy (SG) is a controversial issue and diagnostic dilemma. Strong heterogeneity exists in the assessment of reflux post-SG, and better diagnostic tools are needed to characterize symptomatic reflux. We aimed to determine the discriminant factors of symptomatic reflux and establish diagnostic thresholds for GERD following SG. Materials and Methods Patients post-SG were categorized into asymptomatic and symptomatic cohorts and completed validated symptom questionnaires. All patients underwent stationary esophageal manometry and 24-h ambulatory pH monitoring. Univariate and multivariate analyses were conducted to determine the strongest discriminant factors for GERD. Results Baseline characteristics of the asymptomatic cohort (n = 48) and symptomatic cohort (n = 76) were comparable. The median post-operative duration was 7.3 (14.1) vs 7.5 (10.7) months (p = 0.825). The symptomatic cohort was more female predominant (90.8 vs 72.9%, p = 0.008). Reflux scores were significantly higher in the symptomatic group (36.0 vs 10.5, p = 0.003). Stationary manometry parameters were similar, including hiatus hernia prevalence and impaired esophageal motility. The symptomatic cohort had significantly higher total acid exposure, especially while supine (11.3% vs 0.6%, p < 0.001). Univariate and multivariate regressions delineated reflux score and supine acid exposure as discriminant factors for symptomatic reflux. The thresholds for distinguishing symptomatic reflux are as follows: reflux score of 11.5 (sensitivity 84.0%, specificity 68.2%) and supine acid exposure of 2.65% (sensitivity 67.1%, specificity 70.8%). Conclusion A reflux score of 11.5 or more or supine acid exposure of 2.65% or more should be considered diagnostic in defining symptomatic reflux following SG.